By Rose Hoban
A bill that would change the relationship between certified nurse-midwives and doctors, giving the midwives more latitude in their practice, passed its test in the House Health Committee Tuesday morning.
The bill, which would remove the need for physician supervision of the nurse-midwives but retains an obligation for the two professions to collaborate, passed with votes from both sides of the aisle after a long, impassioned debate in which the final outcome was more uncertain than most measures this legislative session.
“We’re thrilled,” said Suzanne Wertman, a midwife from Wilmington who came to observe the vote. “But we know we have a long way to go.”
At issue is how the two professions operate together. Currently, the law requires that doctors “supervise” nurse-midwives, who usually practice in hospitals or at one of several birthing centers around the state. But supervision doesn’t mean that doctors need to be in the same room, or even the same county, as the midwife he or she supervises.
“I do understand that there are midwives who were working under supervision of a physician, and the nurse-midwives were working in Wilmington while the supervisor was in Asheville,” bill sponsor Rep. Sarah Stevens (R-Mt Airy) told the committee.
However, if a nurse-midwife does not have a supervisory relationship with a physician, she is rendered essentially without a license.
That’s the case for Becky Yates, a nurse-midwife with 30 years of experience, who was at the committee meeting to watch the vote. The doctors supervising Yates’ practice withdrew their support of her practice in 2011.
“In this state, it means we have to have a physician sign a piece of paper so we can work,” Yates said after the vote. “It doesn’t mean we have a a physician standing over our shoulder, or even in the same building, or even in the same county, for that matter. It’s just a formality, really.”
Yates tried to do contract work in South Dakota, but was unable to because the loss of supervision meant her license was suspended.
She is now retraining to be a breast-feeding consultant.
During the debate, Rep. Jim Fulghum (R-Raleigh), a physician, summoned the legal counsel for the N.C. Medical Board to talk about how, if the bill moved forward, it would be allowing nurse-midwives to practice medicine by proxy.
“We view this through the lens that we also view physician assistants and nurse practitioners,” said the Medical Board’s Thomas Mansfield. “What’s curious to us about this bill is it sort of leapfrogs the nurse-midwives over the nurse practitioners, who are supervised by the physician to provide health care.”
A board made up of members of the Board of Nursing and the Medical Board currently supervise the practice of nurse-midwives.
“From the Medical Board’s perspective, it’s critical that a physician continue to be ultimately responsible,” Mansfield said.
Nurse-midwives are required to carry their own medical malpractice insurance. Stevens’ bill would require them to have a collaborative relationship with a local doctor, someone who could be called in the event of complications during a birth.
An amendment introduced by Rep. Mark Hollo (R-Taylorsville), a physician assistant, would have “gutted and amended” the bill, replacing all the language with a substitute provision to conduct a study on changing the nurse-midwife practice.
“I respect the work these people do in the state,” Fulghum said. “It’s needed and they’re well trained, and in the integrated practices in which they practice in the hospitals I fully support them.
“The idea that this is not a major change, though, is a mistake; it is a major change.
The amendment failed.
In answer to a query about whether nurse-midwives would be able to perform abortions in any form, bill sponsor Stevens assured the panel the bill excluded midwives from performing abortions or prescribing the abortion pill, commonly known as RU 486.
As the discussion reached an end, Rep. Tricia Cotham (D-Matthews), who is visibly pregnant, made an emotional disclosure about losing a baby during a previous pregnancy, before giving birth to her son.
“I think about my last pregnancy, when my son was born, and I was healthy and everything was normal and good. And at the due date, things did not go well,” Cotham told the committee. “I worry what would have happened to me; I worry about what would have happened to (my son).”
She told of an email received by all the representatives from a woman whose home birth went awry when her uterus ruptured. The baby died.
Stevens told her that there is a requirement in the bill that midwives have in place a transfer plan in case problems arise during births outside a hospital.
Things can go wrong in a split second, Cotham said. “At this time, I cannot support this bill. I hope that someday I can.”
The bill passed by a 12-7 vote and now moves to a House judiciary committee.
“We’ve worked to get support from members in both caucuses; we have 24 co-sponsors from both sides of the aisle,” said lobbyist Alex Miller, who has been working on behalf of the nurse-midwives.
“If it gets past the House in this long session, the Senate can take it up during this session or it carries over to the short session,” he said.
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Practice 18th century medicine and expect a 21st century outcome….What could be wrong with that?